This is a renewal of a project in which 375 depressed patients aged 60 years and over will be followed for two to ten years, with a focus on cognition as a primary outcome. 250 patients from the current funding period will continue to be followed, and 125 new patients will be added in the first 30 months of the study. Detailed psychosocial, functional, functional, clinical, psychiatric, medical, neurological, and cognitive assessments will occur at intake and defined points during follow-up. Brain MRI studies will be performed at intake and once again two years later. The principal outcome measures are cognitive decline and dementia. The investigators will continue to examine depression outcomes. The analysis plan focuses on examination of risk for cognitive decline and later dementia using the following independent variables: change in fronto-striatal lesion burden, change in hippocampal volume, APOE genotype, and depression course. The project will preserve past methodological advances by combining and psychiatric assessments with psychosocial and psychobiological perspectives. In a study design that employs carefully defined treatment protocols, we will test specific hypothesis regarding cognitive decline and dementia in depression. While several studies have noted an increased risk of later dementia among depressed elderly, how one may predict incident dementia in older depressed adults is unclear. This application will focus on clinical variables (course of depression), neuroimaging variables (changes in fronto-striatal lesions) and genetics (APOE genotype) as predictors of cognitive decline and dementia in a group of older depressives and a group of elderly controls. Psychosocial factors will be used as co-variates. It is expected that the results from this study will clarify the relationship between depression and dementia in the elderly. It will also add to the literature on the long-term outcome of depression in a clinical setting. Ultimately it should aid in the clinical management of geriatric depression, shedding light on the prognosis for cognitive outcomes of depression in the elderly, as well as for long-term recovery and remission of depression symptoms.